HIV patients should begin antiretroviral treatments earlier than what current guidelines recommend, according to a new study presented by physician and HIV/AIDS specialist Mari Kitahata of the University of Washington in Seattle. The study that involved more than 8,000 HIV patients suggests doctors should rethink the standard practice of HIV treatment.

Currently, treatment is based on the number of CD4 immune system cells. The standard treatment had been a count of 200 per milliliter of blood and was recently raised to 350. US and Canadian researchers say treatment should begin when the CD4 count reaches 500.

Kitahata and her colleagues analyzed data from 22 studies of people from Canada and the United States who started HIV treatment between 1996 and 2006. The researchers compared data of 5,901 patients who followed more standard treatment guidelines and did not begin treatment until CD4 counts were below 350, to 2,473 patients who began treatment when their CD4 counts were between 351 and 500.

The study found that the patients who delayed treatments were 71% more likely to die during the course of the study period than those who began treatments early. Dr. Kitahata said the reduction was “meaningful and substantial,” adding that HIV patients that start treatment earlier than current recommendations have less risk of dying from the disease.
“This does impact on and differ from current guidelines and recommends treatment earlier in disease,” she said. “All patients with a CD4 count 500 and below should receive anti-retroviral treatment.”

Infection with HIV is associated with a progressive decrease of the CD4+ T cell count and an increase in viral load. The stage of infection can be determined by measuring the patient's CD4+ T cell count, and the level of HIV in the blood.
The study’s findings were reported at a conference held by the American Society of Microbiology and the Infectious Disease Society of America.

UNAIDS estimate the deadly virus has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive pandemics in recorded history. Sub-Saharan Africa remains the worst-affected region, with an estimated 21.6 to 27.4 million people currently living with HIV.

The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. Only male and female condoms can reduce the risk of heterosexual HIV transmission. HIV affects nearly every organ system. Patients with HIV infection have substantially increased incidence of several malignant cancers and tuberculosis.
Many HIV-positive people are unaware that they are infected with the virus. The CDC urged for “new strategies such as expanded screening in health-care settings” to have an early diagnosis of HIV and recommended that the HIV test should become a standard test during an ordinary doctor’s visit. CDC scientists began recommending universal HIV testing in September 2006 to reduce the number of Americans who are infected with the virus but are unaware of it and, as a result, risk spreading it.